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Effect of CMV Mismatch on Heart Transplant Outcomes Using a Surveillance and Preemptive Strategy

Lookup NU author(s): Dr Guy MacGowanORCiD, Dr Adam McDiarmid, Dr Gareth Parry

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Abstract

© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Purpose: The aim of the study was to determine outcomes after heart transplantation for cytomegalovirus (CMV) mismatched patients (D+/R−) who underwent a surveillance and preemptive therapy protocol, compared to nonmismatch patients. Methods: A review of patient records from January 2010 to December 2020 with follow-up to October 2023 was done. The protocol consisted weekly surveillance with CMV PCR starting 4 weeks after transplant continuing up until the patient seroconverts or up to 3 months posttransplant if the patient does not seroconvert. Valganciclovir was given for 2 weeks to those who seroconverted. Results: Two hundred and twenty-one patients were included, and 23% were mismatched patients. Overall survival was not different between CMV groups (p = NS). Causes of death and morbidities were also not significantly different (p = NS). Sixty-six percent of mismatch patients seroconverted, and there was also a significantly older donor age in the seroconverted patients compared to nonseroconverted patients (41 ± 11 vs. 29 ± 12 years, p < 0.005), indicating a higher risk donor profile. A multivariate Cox regression including donor age showed that there was no increase in mortality in the seroconverted mismatches compared to nonmismatch patients (p = NS). Conclusions: There is no significant increased mortality or morbidity using a CMV surveillance and preemptive therapy protocol. The effect of donor age on seroconversion of mismatches requires further validation.

Publication metadata

Author(s): MacGowan GA, Samuel J, McDiarmid A, Gonzalez-Fernandez O, Parry G

Publication type: Article

Publication status: Published

Journal: Clinical Transplantation

Year: 2024

Volume: 38

Issue: 9

Online publication date: 05/09/2024

Acceptance date: 24/07/2024

ISSN (print): 0902-0063

ISSN (electronic): 1399-0012

Publisher: John Wiley and Sons Inc.

URL: .https:/doi.org/10.1111/ctr.15419

DOI: 10.1111/ctr.15419

PubMed id: 39235071

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